Ovarian ectopic pregnancy: applicability of transvaginal and color doppler sonography in early diagnosis. Clinical and therapeutical correlation

Abstract

OBJECTIVE: Ovarian pregnancy (OP) is a rare form of ectopic pregnancy (EP) (1/6000 to 1/40000 pregnancies). Spielberg's diagnosis criteria is not always possible, and the lack of an absolute profile for patients with OP, makes this diagnosis difficult. The aim of this study was to evaluate the accuracy of transvaginal ultrasound (TVS) and color Doppler (CD) examination for diagnosis of OP, its surgical treatment and clinical outcome. DESIGN: Descriptive clinical study. MATERIALS AND METHODS: From 1997 to 2007, 11635 first trimester pregnancies were evaluated by TVS and CD. A total of 4 OP were detected and prospectively evaluated. TVS was used to establish the absence of intrauterine pregnancy, location of OP, size of ovarian ring (OR), and the presence of free fluid. CD evaluated blood flow in the OR and was correlated with surgical findings. B-hCG levels and type of pain referred by the patient was documented and laparoscopy was performed. Morphological and histological findings, surgical treatment and follow up were registered. RESULTS: The incidence of OP was 0.34‰ (4:11635). OP was associated to intrauterine device, to intrauterine insemination, to IVF and to homolateral benign teratoma. TVS revealed absence of intrauterine sac, an ovarian enlargement associated to the presence of a OR within or in contact with the ovary in all cases. OP was more frequent at the right (75%) than at the left side (25%). The diameters of the OR were 11, 12, 19 and 33mm. Free fluid was significant in 3 cases (75%) and scarce in 1(25%). CD was performed in 3 cases showing vascularization of the OR with suggestive parameters for trophoblastic flow. Three patients (75%) presented severe abdominal pain and 1 (25%) was asymptomatic. B-hCG titters ranged between 1300 and 3200 mU/ml. Diagnosis was made between 4.6 and 6 weeks of amenorrhea. In all cases EP were diagnosed prior to laparoscopy, with a strong suspicion of OP in three of them. Laparoscopy confirmed diagnosis and only OR resection were performed. Fallopian tubes had normal appearance. Pathologist reported OP in three cases and EP in one case. Follow up showed normal evolution. Two patients became pregnant. CONCLUSIONS: Diagnostic presumption of OP can be reached by combining clinical symptoms, BhCG titters, ultrasound results, and confirmed by laparoscopy and/or histology. Early diagnosis can prevent serious complications and allows conservative ovarian treatment, preserving fertility in these women.